Got Back Pain?

Clues from my personal, two-year study about how to manage and resolve back pain.

For about two years now, I have been building a daily record of diet and exercise, and I have been monitoring four manifestations of back pain.  The question is: Can the record of diet and exercise reveal any clues about how to promote healing and resolve back issues?  Quick answer: There are clues, and some clues accord with popular remedies.

Blessed are those of us who have not ever found themselves puzzling over their own back pain.  And, yet, further puzzling to those who have puzzled over such things is the fact that back pain seems to defy crisp understanding and simple remedies.  Indeed, if one does a little casual research, one can easily find unhelpful bits of wisdom which go to the effect of “The causes of back pain are diverse.”  Worse, one can find conflicting prescriptions like “Blueberries reduce inflammation,” and “Blueberries increase inflammation.”  What is going on, and what adaptations to one’s regular diet and exercise routines can reduce pain and promote long-term healing?  Anything?

There is nothing like tuning up some data and contemplating data exercises to help one appreciate how tricky it can be to study such amorphous matters as “back pain.”  For example, can one distinguish things that actually promote healing from things that merely mask pain?  Can masking pain frustrate healing over the longer-term?  Can it make sense to subject certain joints and muscles to modest stresses with the expectation that those joints and muscles will respond favorably?  Would shielding those joints and muscles from stresses promote atrophy, the destabilization of joints, or the stiffening of joints?  Alternatively, when can it make to sense to give certain joints and muscles a rest?

I have some formative results.  I’ve made a point of ranking different types of pain in my lower back when I first get up in the morning.  I indicate “0” for no appreciable pain or stiffness.  I always wake up with some stiffness, but not necessarily discomfort that I’d notice absent some conscious effort to measure it.  I indicate “1” for a discrete manifestation of modest discomfort.  I indicate higher rankings—2, 3 and even 4—for severe pain.  “4” is bad—like I might have to roll off the bed like a log in order to avoid stressing the lower lumbar area.

Most days I assign a “0” to a given dimension of pain, but the occasional “1” is not unusual.  Higher rankings mostly attend injuries…  like, I may have been at the gym doing one of my usual exercises but might have been a little careless with some free weights.  So, for example, I’ve had the experience of taking some heavy dumbbells from the rack and then deciding to change the incline of the weight-lifting bench.  But, important lesson to myself: Don’t be lazy; go back and re-rack the dumbbells before adjusting the bench; don’t place them on the floor next to the bench only to have to pick them up all the way up from the floor; the lower back can be sensitive to seemingly modest stresses—stresses which may not be very modest at all—and I can end up with a stressed-out lower back.

Higher rankings may also attend long-running issues.  For example, I’ve had issues with one of the two sacroiliac joints forever.  I had not necessarily identified certain, familiar discomfort with the sacroiliac joint, but further research and observation suggests that’s just what certain discomfort derives from.  When say, 16 miles out on a long bike ride, and after climbing steep hills, some discomfort might develop above the lumbar area (up around the lower thoracic vertebrae) on my right side.  This pain may derive not from problems with the thoracic vertebrae but from “sacroiliac joint dysfunction.”

Note: Physical trainers have been useless.  I’ve seen them now and then over the years, and they have had nothing to offer other than suggestions to keep coming in to their studios for the privilege of paying them for canned “therapy” routines.

I keep track of four “dependent variables”:

(1)   “Lower back pain” – by this I mean simply generalized, symmetric discomfort around the lower lumbar region when I first roll out of bed.

(2)   “The wash face test” – If the first thing I do after rolling out of bed is wash my face, do I feel much discomfort in merely bending over the bathroom sink?

I’ve started to allow myself to use the “A” word: “Arthritis”.  Correct or not, this business of having difficulty first thing in the morning with just bending over to wash my face seems to be a common manifestation of arthritis.  Sure enough, just walking up a set of stairs will expel the discomfort.  Just stepping into a hot shower will also yield instant relief.  But, again, it can be hard to do something simple like wash my face right after I get out of bed.

The meaning of the A-word to me is: this is not something that is just going to go away.  Maybe keeping up with a “low-inflammation diet” might do the trick, but, that can sometimes be challenging.  Even so, what can I do to mitigate the discomfort?

(3)   “Sacroiliac joint pain” – When I roll out of bed, do I feel some discomfort in the “SI joint” on the right side?

(4)   “Iliopsoas pain” – The iliopsoas complex of muscles comprise some of the “hip flexors.”  These muscles engage when one is doing leg lifts.  But, these muscles can get tight.  The conventional wisdom is that sitting all day at a desk keeps these muscles in a contracted position.  Taking a walk around the office can loosen them up.

I can experience iliopsoas pain on my right side.  All of my issues are on my right side.

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I am not going to enumerate all of the control variables that I keep track of, but I will make two almost-redundant sweeps through the results of my ever-ongoing analysis.  I will first identify things that seem to reduce pain or aggravate pain.  I will then go through each of the four conditions and report again what things seem to aggravate that condition or remedy that condition.

Technical note: I run four different regressions, specifically an “ordered probit” for each of the four pain measurements.  I map these four dimensions of pain against a host of categorical variables.  For example: Did I consume “red meat,” yes or no?  “Oily fish” like salmon (yes or no?) which are high in “omega-3 oils” (which ostensibly suppress inflammation and promote healing)?  Did I have a weight-lifting session at the gym, yes or no?  Then there are real-valued metrics, such as “Cycling” (distance traveled) or “Running” (distance traveled).

Some of the variables are too crude to pick up important differences in, say, a given exercise session.  So, for example, I may have gone out for a long bike ride, but did I go out on a hilly route?  That might matter, because grinding up long hills can put a lot of strain on my lower back.  Does such strain aggravate pains, or can it promote strengthening or healing in my lower back?  And, again, is some pain consistent with healing, or does it reveal dysfunction?

I map the four pain conditions against lagged values of the control variables.  I include the one-day lag, two-day lag and three-day lag in the regression analyses.  So, an important limitation of this study is that I really am just looking at short-term effects.  I have looked for lagged effects as long as, say, two weeks out, but I don’t have confidence that the analysis reveals any robust patterns.

I have only one thing to say about longer-term effects: I toss a linear time trend into the regression equations.  I report results that are robust to inclusion or exclusion of the time trend, but the time trend itself reveals an important result: Giving myself time to heal up from certain injuries can be a very good idea.  All four measures of back pain responded well to the passage of time.  Specifically, I started recording data at a time when my back issues were extreme—extreme by the standards of my long experience with them.  I got to the point that I was thinking it could be wise to entirely give up on running, and I was worried that even cycling might prove problematic.  But throttling back on the running and laying off the long bike-rides for some time seem to have enabled me to heal up appreciably.  I go out for the occasional, not-very-long run without difficulties.  I get out on my bike routinely, although I have been laying off certain types of routes… for now.

What things work and don’t work

Time

Give oneself time to heal.

Taking a break from certain physical exercises can be important.  Taking a break can be a hard thing to do, but let me suggest that exercise amounts to physical trauma.  One’s body will respond to trauma, but the body has engineering limits.  A little trauma here and there can help expand those limits, but too much trauma can wear down one’s joints and one’s capacity to perform.  Think of each day of not exercising as a day in which your body gets to heal itself.

Sleep: A good night’s sleep can make one stiffer in the morning.

A good night’s sleep may promote healing, but not moving around, it seems, can make one stiff in the morning.  It looks like there can be an advantage to tossing-and-turning: the joints and muscles get a chance to breath, and one may be less stiff in the morning.

Eggs

What is it about eggs that seems to promote healing—or, at least, reduce pain—across all four dimensions of pain?  Is it the protein profile or the sulfur compounds?

Eggs show up as a big winner.

Oily fish

Maybe there is something to this business of consuming foods rich in omega-3 oils.  There are suggestions in the data that oily fish can reduce generalized “lower back pain” and “iliopsoas pain.”  Why might that be?  I have read pieces suggesting that fish oils can reduce pain, but I worry that they merely mask pain.

Fish oil supplements

There are suggestions in the data that fish oil supplements are more potent than “oily fish” itself.  Interesting.

Animal protein is good.

Red meat, poultry, fish: We are wired to consume animal proteins, and they do not aggravate pains.  If anything, animal proteins reduce pain.  Perhaps the protein profiles and other nutrients and fats that come with those proteins provide the nutrition the body does require to repair itself and to respond to the trauma one may have inflicted on it.

Asparagus

Yes, “asparagus” is very specific, but it shows up as reducing arthritic pain (as measured by the “wash face test”) and joint pain (as measured by “sacroiliac joint pain”).

Some research credits the sulfur compounds in asparagus.  These things are supposed to be good for rebuilding joints.

Leafy greens

“Leafy greens” amounts to a very crude measurement in that I include spinach (high in iron), lettuces (high in nothing, really) and other greens in it.  But, in general, it looks like “leafy greens” reduce pain.

Cheese is good!

I do not consume much in the way of dairy products, and one can find indications that dairy promotes inflammation.  But, in my data it shows up as something that reduces sacroiliac joint pain and iliopsoas pain.  Interesting.

Blueberries can be problematic—or not.

Blueberries show up prominently as aggravators of arthritis pain (as measured by the “wash face test”), but they seem to mitigate iliopsoas pain.

Collagen supplements – no obvious, short-term benefit.

I have experimented with periodically blending shakes that include “hydrolyzed collagen.”  People insist it helps.  I have not discerned a positive effect.  If anything, the data suggest that collagen can aggravate pain.  But, might such discomfort be consistent with the body deploying that collagen and healing itself?

Glucosamine and chondroitin

To my pleasant surprise, it looks like glucosamine and chondroitin supplements really do reduce pain.  People do take such supplements explicitly to deal with arthritis pain, and my data suggest that such supplements can reduce sacroiliac joint pain and can reduce pain experienced during the “wash face test”.  Interesting.

Turmeric may promote immediate pain relief, but it doesn’t last over days.

Certain turmeric concoctions (blended with black pepper) are a thing, and I really do think that they reduce pain, but like aspirin or ibuprofen, the effects are not discernible from one day to the next.

Weightlifting is good for you!

If I were to suggest only two things one could do for oneself, I’d say, eat eggs and lift weights.  Just be careful with the weights, and be patient with oneself.  Don’t compare yourself to other people in the weight room.  The only person you need to compete with is your harshest, meanest critic: yourself.  That may sound like new-agey, politically-correct rhetoric, but I mean it.  Just get in some periodic weight training, and come up with a not-too repetitive program that works for you.

Yoga can frustrate healing.

I get a lot out of deep stretching, but the data seem to indicate that I should avoid digging too deeply into the sacroiliac joint.

Cycling can be very good for you.

I was very pleased to see that “cycling” shows up mostly as a good influence.  There is some suggestion that “cycling” can aggravate the sacroiliac joint, but maybe I need to take more care when doing long, steep climbs.  Specifically for me: Suppress the impulse to stand up in the saddle and grind up long, steep hills; stay seated when grinding up long hills.

Walking: Museum-walk kills me!

I do not often record “walking” as an activity, because, when I move around, I hustle.  I only find myself walking when, say, I am visiting a museum or I’ve been asked to go out for a walk.  But, walking slowly really aggravates the sacroiliac joint pain and the iliopsoas pain.

Running seems fine.

To my pleasant surprise, I don’t see any adverse, short-term effects from running.  Now, granted, these days I run slowly and run short distances (about 5 km/3 miles).  But, that’s enough for me.  I’ve given up on the idea of trying to run a relatively flat 5-mile route at a 7-minute, 30-second pace.

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Now, let’s go through the data again, except let me organize the narrative by each of the four conditions.

How to resolve generalized lower back pain:

Eat eggs, red meat and greens.  Oily fish and poultry are fine.  Collagen doesn’t help.  Yoga does not hurt, and cycling seems to make an appreciable difference.

How to deal with sacroiliac joint pain:

Eggs and cheese are great.  Asparagus is good.  Collagen does not help, but glucosamine-and-chondroitin supplements seem to help.

Lift weights!!  It could make sense to avoid dead-weight lifts and squats, but substitute those with some good sessions of leg presses in those leg press machines.

Avoid slow walking.  Running is fine.  Cycling can aggravate the joint.  Certain yoga exercises can also aggravate the joint, and it is not obvious that aggravating the joint induces the joint to respond to such trauma favorably.

What to do about morning stiffness/arthritis:

Fish oil does seem to help.  Asparagus, greens and poultry, too.  Blueberries aggravate the pain, but the common arthritis remedy of glucosamine and chondroitin supplements help.

All forms of exercise seem to have no effect one way or the other.  Which is interesting.  This kind of mild, common arthritis really does seem to be a matter of just moving around a little bit.  I find that doing squats at my standing desk or walking up stairs (one step at a time) helps.  I do find that walking up stairs two steps at a time can aggravate the SI joint.

A hot shower gives immediate relief.

What to do about iliopsoas pain:

Cycling is good.  Weight-lifting is better.  Yoga can aggravate the pain.  Blueberries seem to help.  Cheese, oily fish, and fish oil supplements help.

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The Top-three at Three

I will continue gathering data, but right now I would say that my top-three prescriptions would be: Eat your eggs, eat asparagus, and develop a good weight-lifting program.  Beyond that: Don’t sit around too much.  Walk around the office, and take the stairs … one step at a time.

I’d go further and suggest that vegans really do harm themselves.  They’re just not getting the profiles of nutrients their bodies need to heal and restore themselves.